St. Clair Hospital aids clot-prevention efforts

An ongoing quality improvement project at St. Clair Hospital in Mount Lebanon has yielded a significant reduction in the number of blood clots that patients experience, saving lives and health care costs.

With research help from Robert Morris University, St. Clair reduced the number of life threatening blood clots that lodge in the lungs by 68 percent while cutting the number of other kinds of blood clots by 18 percent during fiscal year 2012.

Identifying the likely causes of the clots and information technology improvements, which make blood test results immediately available at the patient’s bedside, were credited for the reductions, said Dr. G. Alan Yeasted, chief medical officer.

“It enables the nurse to have the information right there,” Yeasted said. “We have a really good information technology department.”

St. Clair was among the hospitals invited to health insurer Highmark’s annual Quality Blue forum Nov. 8 in Harrisburg. Hospitals’ representatives were scheduled to present best practices information on reducing infections, number of readmissions and other issues confronting hospitals.

Highmark financially rewards hospitals that achieve quality improvement goals they set. Although the amount of St. Clair’s bonus for reaching its goal was not disclosed, the program overall made $92 million available to participating hospitals for quality improvement efforts.

“To be care-effective, you have to be cost efficient,” said Holly Hampe, director of quality at St. Clair. “When you take the waste out of the system, you become more efficient and effective.”

Several years ago, St. Clair adopted Toyota lean manufacturing principles to identify and solve quality of care issues, including such things as improving the patient experience in the emergency department.

Blood clots are the most preventable cause of death in health care, accounting for 60,000 to 100,000 deaths annually, Hampe said. Clots are treated with blood thinners and patients prescribed these medications can be difficult to manage because the dosage needed can quickly change depending on the patient’s diet and other factors.

Having blood test results available at bedside means nurses can question a prescribed dosage before administering it, if needed, Hampe said.

With help from a Jewish Healthcare Foundation grant, a Robert Morris nursing practice student reviewed nearly 2,000 patient charts to find correlations between blood clots and other factors, according to Judith Kaufmann, who directs RMU’s doctorate of nursing practice program.

Some of the surprising results: smokers with heart disease were 14 times as likely as nonsmokers without heart disease to develop a blood clot; and the risk of blood clots was higher in patients who received their own blood in transfusions.

“St. Clair has been incredibly receptive to joining forces to help us help them,” Kaufmann said. “It was a wonderful relationship.”

The Harrisburg conference was designed to spotlight best practices in addressing problems such as hospital-acquired infections, said Linda Weiland, vice president of provider innovation at Highmark.

Sepsis, surgical safety and diabetes were other issues that were to be discussed at the forum.

During the past five years, 2,527 infections were potentially averted with savings of more than $43 million through Highmark’s Quality Blue initiative. In fiscal 2012, 29 hospitals participated in a surgical safety programs, which resulted in averting 739 surgical site infections at a savings of at least $2 million, according to the insurer.